A mammoth undertaking

Yesterday I saw the palliative care consultant, and was scheduled to see the oncology consultant. I spent a long time with the palliative care consultant, and by the end of the meeting it really wasn’t necessary to see the oncology consultant, as we had covered all my signs and symptoms in the first meeting.

The consultant seemed most concerned about the daily vomiting, and we spent most of our time discussing this before settling on a new approach. I’ll be reducing the Metoclopramide dose back to 10mg three times per day, and replacing the night time dose with 6mg Levomepromazine. Apparently the new drug acts on one pathway that no other drug does, so it may be of some use.

Next we turned to improving the pain management. First, I had noticed that my prescription for Diclofenac was now 50mg twice per day, and I was sure it was 75mg at first. Somehow something had got mistranscribed at the GP Surgery, and it turned out that I was right. Worse, the 50mg dose wasn’t a slow release version of the drug, so it was even less useful.

Second, the consultant seemed to think that I was too tolerant of pain, and should be more willing to tackle breakthrough pain by using the OxyNorm liquid. It’s true that I have been somewhat reluctant to do so, so I promised to try harder over the next few weeks not to put up with any pain at all. Indeed, I know perfectly well that pain is a signal that something is wrong, and it is intended that it should be got rid of, preferably by getting rid of the pain-causing agent. In my case, and that of most cancer sufferers, that’s not an option, so we take the second course, which is to take pain killers. Killing the pain completely is a really good way to improve quality of life. It’s one thing to know this intellectually, but another to put it into practice, I have found. However, I will try harder. I shall also be taking 10mg OxyContin twice per day, and splitting my dose of Omeprazole to 20mg twice per day, just before taking the Diclofenac. Complicated, I know, but it all makes sense.

Finally, it was agreed that a scan would be needed to try to determine why I’m being so sick and getting so much pain. That was scheduled by the oncology SHO at the end of the afternoon, and I expect to receive a letter telling me when it will be in the next few days.

Last night my appetite was much improved, without even changing the drugs regime yet. Strange, but true. I slept much better last night than I have done recently, probably due in part to the improved pain killing regime. This morning I woke up and didn’t feel sick for the first time in ten days or more, and thought that we had done the trick. But the feeling didn’t last as I lost my sacrificial cup of tea as soon as I had drunk it — 40 minutes after taking my morning pills, so I hope they’ll have had enough time to get into my blood stream. I’ve split my morning and evening pill taking into before- and after-meal pills, and the pain killers are in the after-meal group. Those I kept down successfully today. I’ve eaten and drunk more today than in the past few days, so to that extent the new anti-emetic seems to be working. It’ll all be news for when the palliative care nurse phones me tomorrow to find out how things are going.